African countries want information about pathogens with the potential to cause pandemics to be shared “exclusively” through a global system currently being negotiated at the World Health Organization (WHO) – yet at the same time, their governments are under pressure to agree to bilateral Memorandums of Understanding (MOU) with the United States that will trade their pathogen information for health aid.

“We envision a PABS [Pathogen Access and Benefit-Sharing] system that ensures that all PABS materials and sequence information flow exclusively through the [WHO] system,” said Zimbabwe, speaking on behalf of 50 African member states.

He was addressing the Intergovernmental Working Group (IGWG), charged with negotiating the PABS system, at the end of last week’s text-based negotiations.

Once agreed, the PABS system will become an annex to the WHO’s Pandemic Agreement, setting out how information about pathogens with pandemic potential is shared in a safe, transparent and accountable manner, and how those who share this information will benefit from vaccines, diagnostics and therapeautics that are developed as a result.

Under pressure from the US

However, the US government is currently negotiating MOUs with several African countries that aim to compel them to share all information about “pathogens with epidemic potential” in exchange for aid to address HIV, tuberculosis and malaria, Health Policy Watch reported exclusively last week.

Several countries have little power to refuse the terms of the MOUs as they face mounting deaths and illness of their citizens without resources to buy essential antiretroviral, TB and malaria medication, mosquito nets and other medical necessities. 

The loss of aid from the US President’s Emergency Plan for AIDS Relief (PEPFAR), combined with a 24% reduction from other large donors, is predicted to “cause an additional 4·43 to 10·75 million new HIV infections and 0·77 to 2·93 million HIV-related deaths between 2025 and 2030 compared with the status quo,” according to a modelling study published in The Lancet in May.

The MOUs are part of the US’s new America First Global Health Strategy, which is based on  “keeping America safe, strong and prosperous”.

However, several health leaders have expressed concern that sharing the information of dangerous pathogen via numerous bilateral agreements, rather than via one centralised PABS system under the WHO, will slow down the world’s response to future pandemics.

Undermine multilateralism

“These bilateral agreements will undermine the multilateral system. They will bypass the WHO, and the foundations of solidarity and equity we have been trying to build here,” Dr Michel Kazatchkine, a member of the Independent Panel for Pandemic Preparedness and Response, told the IGWG last week.

“The template offers no guarantees of access to countermeasures and gives commercial dominance to one country. It threatens health security, data security and ultimately national sovereignty.”

Nina Schwalbe, CEO of Spark Street Advisors, described the draft MOUs as “pure bullying by the US and a terrible deal for any country”. 

The bilateral MOUs propose that the US “gives a bit of aid for a few diseases for just a few years at best – and in return they give access to physical specimens and genetic sequence data for 25 years,” said Schwalbe. 

“There is zero promise by the US to provide any of the resulting drugs, diagnostics or vaccines [it] develops using their data. This is not a fair deal. It is a powerful country exerting its muscle once again put itself first in line,” she added.

Jamie Love, head of Knowledge Ecology International, said it is “not surprising that the US is undermining the WHO negotiations”.

‘But Trump won’t be President forever, and the pandemic treaty will be around longer. I don’t think [the bilateral agreements] will kill the Pandemic Agreement, but it certainly is designed to undermine the equity provisions and reduce the industry incentives to participate in the near term.”

Kazatchkine said that, while the Panel “fully understands that some countries will consider entering into these agreements”, it “cannot stress enough the importance of a multilateral approach for pandemic prevention, preparedness and response”. 

‘Solidarity is our best immunity’

The WHO told Health Policy Watch that it has “not received any official information”about the US MOUs. 

“However, WHO member states are working actively to develop the PABS system as part of the already adopted WHO Pandemic Agreement,” the WHO spokesperson added.

“Solidarity is our best immunity. Finalising the Pandemic Agreement through a commitment to multilateral action, is our collective promise to protect humanity,” WHO Director General Dr Tedros Adhanom Ghebreyesus told IGWG

“To enable a timely and effective response to future pandemics, countries must be able to quickly identify pathogens that have pandemic potential and share their genetic information and material so scientists can develop tools like tests, treatments, and vaccines,” the WHO explained.

The PABS system is envisaged to facilitate both the rapid and timely sharing of biological material and sequence information from pathogens with pandemic potential on the one hand, and enable the “rapid, timely, fair and equitable sharing of benefits” – such as vaccines – that arise from sharing this information. 

IGWG Bureau co-chair Ambassador Tovar da Silva Nunes said that member states had shown during last week’s meeting that they are capable of the difficult conversations “that will make the world safer from the threat of future pandemics”.

“By considering complex issues head-on, these negotiations are ensuring that future pandemic responses will be fair, timely and grounded in solidarity,” said da Silva Nunes.

“Seeing the member states’ disposition to tackle these issues, I am optimistic that we will deliver a finalised annex to the World Health Assembly for adoption in May 2026.”